System and method for integrating data with guidelines to generate displays containing the guidelines and data

ABSTRACT

A system and method for automatically integrating data with guidelines to generate displays containing the guidelines and data. The automated system and method can integrate patient data with treatment guidelines to assist a healthcare provider, such as a physician or the like, in providing treatment to the patient. The system and method employ a data storage component, adapted to store guideline data representing guidelines for assessing a condition of an entity, guidelines for taking action on the entity, or both, and to store feature data representing at least one feature of the entity. The system and method further employ an output device, adapted to output at least one diagram representing the guideline data, with the diagram including at least one component representing a relationship of at least a portion of the feature data to at least a portion of the guideline data. The guideline and feature data could pertain to a medical condition, such as diabetes, and the output device could output the diagram as a display or a printed diagram.

[0001] This application claims benefit under 35 U.S.C. § 119(e) fromprovisional patent application Serial No. 60/244,845, filed on Nov. 1,2000, the entire content of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The present invention relates to a system and method forautomatically integrating data with guidelines to generate displayscontaining the guidelines and data. More particularly, the presentinvention relates to a system and method that employs a database that iscapable of receiving data, such patient data, statistical data, and thelike, from local or remote locations and integrating the data in adatabase along with guidelines, such as treatment guidelines used bymedical providers, to generate displays containing the guidelines whichare enhanced by the integrated data to provide information pertaining tothe guidelines and recommendations for following the guidelines.

[0004] 2. Description of the Related Art

[0005] As the population in the United States continues to increase,especially among the aging, the ability for traditional healthcareproviders, such as hospitals and doctors' offices, to effectivelyprovide treatment becomes increasingly challenging. In addition, as theaverage age of the population continues to increase, the number ofpeople requiring care for long-term illnesses, such heart disease,diabetes and the like also increases.

[0006] Accordingly, alternatives to traditional health providers arebeing developed to accommodate these greater healthcare needs. Also,more effective and efficient systems are being developed to attempt toreduce the number of medical personnel necessary to treat or monitorpatients. Specifically, systems are being developed that enable patientsto have their conditions monitored at home, such as by themselves or avisiting nurse, and to provide data related to various tests, such bloodpressure measurement, temperature, weight, blood glucose level, and thelike, to a centralized database. These systems are then capable oforganizing the data in an appropriate manner, and providing the data inan appropriate format to a healthcare provider, such a physician, whocan review the data and determine whether the plan of care for thepatient is sufficient or should be modified.

[0007] An example of a healthcare data manipulation and analysis systemis described in U.S. Pat. No. 6,230,142 to Benigno, the entire contentof which is incorporated herein by reference. According to the Benignosystem, a healthcare provider, such as a nurse can obtain patient dataduring a visit with the patient at, for example, the patient's home.This patient data is entered into a database that compares the data totreatment guidelines for the particular patient's disease, and providesa recommended course of treatment for the patient. Other examples ofthis type of system are described in U.S. Pat. Nos. 5,953,074 and5,583,758, both to McGilroy, the entire content of both of these patentsbeing incorporated herein by reference.

[0008] Although the patents cited above describe systems which attemptto gather and analyze patient data and provide some recommended plan oftreatment, these systems are not configured to outline different optionsof patient care. These systems also are not effective in illustrating tothe care provider a comparison between other variations of care plansthat could be followed based on variations in the patient data.Therefore, healthcare providers may find these types of systemsinsufficient because they provide only a specific result for the patientbased on the specific patient test data, and not different options thatcould be provided to the patient were the test data to be different.

[0009] A technique known as Staged Diabetes Management (SDM) exists thatuses diagrams or decision paths to illustrate to a healthcare providerdifferent courses of treatment for a diabetes patient. An example of thestaged diabetes management technique is described in a book by Roger S.Mazze, Ph.D. et al., Staged Diabetes Management—A Systematic Approach(International Diabetes Center, 2000), the entire content of which isincorporated herein by reference. The Staged Diabetes Managementtechnique described in this book is intended to provide a systematicapproach to diabetes care that can significantly reduce averageglycosylated hemoglobin AIC, reduce overall lower extremity amputation,and reduce adverse fetal and prenatal outcomes associated with Type 1diabetes and pregnancy. SDM provides a comprehensive program that offersscientifically based guidelines for the prevention, detection andtreatment of diabetes and its complications, and has proven to enhancethe quality of patient care when compared to standard treatmentapproaches for diabetes.

[0010] Specifically, the SDM technique uses diagrams referred to asdecision paths that incorporate research findings in Type 1 diabetes,Type 2 diabetes, and diabetes in pregnancy, and translates them intotechniques usable for clinical practice. Over the past decade, theprogram has been adapted successfully by more than 10,000 practitionersin 200 diabetes treatment centers worldwide.

[0011] Although the SDM technique has been very successful, it issomewhat difficult to implement in a practical sense because of the needto manually integrate patient data with the SDM guidelines. That is,when a healthcare provider uses the known SDM technique, the healthcareprovider must manually compare the patient data, such as testmeasurements and the like, with the questions and criteria set forth inthe decision paths. Based on this comparison, the healthcare providermanually determines the course of treatment to provide to the patient inview of the guidelines outlined in the decision path. Again, althoughthis technique is successful in achieving the desired results, it may besomewhat difficult for a healthcare provider to use in a practicalsense.

[0012] Accordingly, a need exists for a system and method capable ofintegrating patient data with SDM guidelines, to provide an overallimproved SDM technique.

SUMMARY OF THE INVENTION

[0013] An object of the present invention is to provide a system andmethod for automatically integrating data with guidelines to generatedisplays containing the guidelines and data.

[0014] Another object of the present invention is to provide anautomated system and method for integrating patient data with treatmentguidelines to assist the healthcare provider, such as a physician or thelike, in providing treatment to the patient.

[0015] A further object of the present invention is to provide a systemand method that is capable of receiving data, such patient data,statistical data, and the like, from local or remote locations andintegrating the data in a database along with guidelines, such astreatment guidelines used by medical providers, to generate displayscontaining the guidelines which are enhanced by the integrated data toprovide information pertaining to the guidelines and recommendations forfollowing the guidelines.

[0016] Another object of the present invention is to provide a systemand method for automatically incorporating patient data with a stageddisease management technique to provide integration between the patientdata and the decision pathways for treatment to the healthcare provider.

[0017] These and other objects are substantially achieved by providing asystem and method for integrating guidelines with data. The system andmethod each employ a data storage component, which is adapted to storeguideline data representing guidelines for assessing a condition of anentity, guidelines for taking action on the entity, or both, and whichis further adapted to store feature data representing at least onefeature of the entity. The system and method further employ an outputdevice, adapted to output a diagram representing the guideline data. Thediagram includes at least one component representing a relationship ofat least a portion of the feature data to at least a portion of theguideline data. Specifically, the output device includes a display whichadapted to display the diagram, or a printer which is adapted to printthe diagram. The entity can be a person, in which event the feature datacan represent at least one physical condition of the person, and theguideline data can represent medical information.

BRIEF DESCRIPTION OF THE DRAWINGS

[0018] These and other objects, advantages and novel features of theinvention will be more readily appreciated from the following detaileddescription of a preferred embodiment thereof when read in conjunctionwith the accompanying drawings, in which:

[0019]FIG. 1 is a conceptual block diagram illustrating an example of anetwork adapted for use with a system and method for integrating patientdata with healthcare guidelines according an embodiment of the presentinvention;

[0020]FIG. 2 is a conceptual block diagram illustrating an example ofthe manner in which data is input and output from a data base in anetwork shown in FIG. 1;

[0021]FIG. 3 is a conceptual diagram illustrating an example of themanner in which the network shown in FIG. 1 employing the system andmethod according to an embodiment of the present invention integratespatient data with treatment guidelines;

[0022]FIG. 4 is another conceptual diagram illustrating an example ofthe manner in which the network shown in FIG. 1 employing the system andmethod according to an embodiment of the present invention integratespatient data with treatment guidelines;

[0023]FIG. 5 illustrates an example of a display screen displayed by aworkstations used in conjunction with the network shown in FIG. 1 thatcan be used to generate integrated patent data and guideline displays inaccordance with an embodiment of the present invention;

[0024]FIG. 6 illustrates an example of a screening and diagnosis displayscreen that can be generated on a workstation display in a network shownin FIG. 1 in accordance with an embodiment of the present invention;

[0025]FIG. 7 illustrates a master decision path display screen that canbe generated on a workstation display screen employed in the networkshown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0026]FIG. 8 is an example of a food plan and exercise start displaythat can be displayed on a display screen of a workstation employed inthe network shown in FIG. 1 in accordance with an embodiment of thepresent invention;

[0027]FIG. 9 is an example of a medical visit information display thatcan be displayed on a display screen of a workstation employed in thenetwork shown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0028]FIG. 10 illustrates an example of an insulin stage 2 start displaythat can be generated on a workstation display screen employed in thenetwork shown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0029]FIG. 11 illustrates an example of a Type 2 diabetes stage 2 adjustdisplay that can be generated on a display screen of a workstationemploying the network shown in FIG. 1 in accordance with an embodimentof the present invention;

[0030]FIG. 12 illustrates an example of an insulin stage 3A startdisplay that can be generated on a display screen of a workstationemployed in the network shown in FIG. 1 in accordance with an embodimentof the present invention;

[0031]FIG. 13 illustrates an example of an insulin stage 4A startdisplay that can be generated on a display screen of a workstationemployed in a network shown in FIG. 1 in accordance with an embodimentof the present invention;

[0032]FIG. 14 illustrates an example of a screening and diagnosisdisplay screen as shown in FIG. 6 that further displays a selection boxaccording to an embodiment of the present invention;

[0033]FIG. 15 is an example of a blood pressure display that can bedisplayed on the display screen of a workstation employed in the networkshown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0034]FIG. 16 is an example of a medications and allergies display thatcan be displayed on the display screen of a workstation employed in thenetwork shown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0035]FIG. 17 is an example of a patient update information display thatcan be displayed on a display screen of the workstation employed in thenetwork shown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0036]FIG. 18 is a self management adherence assessment display that canbe generated on display screen of a workstation employed in the networkshown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0037]FIG. 19 is an example of a hypertension diagnosis display that canbe displayed on a display screen of a workstation employed in thenetwork shown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0038]FIG. 20 is an example of a hypertension diagnosis display as shownin FIG. 19 that further displays a box containing desired blood pressurereadings according to an embodiment of the present invention;

[0039]FIG. 21 is an example of a hypertension drug therapy start displaythat can be displayed on a display screen of a workstation employed inthe network shown in FIG. 1 in accordance with an embodiment of thepresent invention;

[0040]FIG. 22 is an example of a diagnosis display that can be displayedon a display screen of a workstation employed in the network shown inFIG. 1 in accordance with an embodiment of the present invention;

[0041]FIG. 23 is an example of a patient intake display that can bedisplayed on a display screen of a workstation employed in the networkshown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0042]FIG. 24 is an example of a print selection display that can bedisplayed on a display screen of a workstation employed in the networkshown in FIG. 1 in accordance with an embodiment of the presentinvention;

[0043]FIG. 25 is another example of a display screen displayed by aworkstations used in conjunction with the network shown in FIG. 1 thatcan be used to generate integrated patent data and guideline displays inaccordance with another embodiment of the present invention; and

[0044]FIG. 26 is another example of a display containing a Type 2diabetes stage 2 adjust pathway that can be generated on a displayscreen of a workstation employing the network shown in FIG. 1 inaccordance with another embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0045]FIG. 1 illustrates a network 100 employing a system and method forintegrating data, such as patient data, with guidelines, such ashealthcare guidelines, according to an embodiment of the presentinvention. The network 100 employs a centralized computer network 102including a database 104 for storing information pertaining to patientsas well as healthcare guidelines as discussed in more detail below. Thenetwork 100 further includes a plurality of workstations 106 which, inthis example, are healthcare provider workstations. These workstations106 can include desktop computer terminals or the like that are capableof accessing the centralized computer network 102 and database 104 via,for example, the Internet 108 or in any other suitable fashion.

[0046] The network 100 further includes a plurality of patient terminals110 that can be used by, for example, the individual patients or ahealthcare provider, such a home care nurse, to record and enter patientdata, such as vital statistics, test results, and so on, into thecentralized database 104. The patient terminals 110 can access thecentralized database 104 via, for example the Internet 108 or in anyother suitable manner in order to provide the data to the centralizeddatabase 104. The centralized database 104 is shown in more detail inFIG. 2.

[0047] Specifically, the database 104 is capable of receiving patientspecific data entry sets 112 via the patient terminals 110 or by anyother suitable method. That is, the patient can take his or her ownvital signs and perform other self-administered tests, such as measuringblood glucose level and so on, and enter this information online via hisor her patient terminal 110. Alternatively, this data can be obtained bya visiting nurse, technician or the like. Also, this data need not beentered via the patient terminal 110, but can be obtained manually andentered into the database 104 via another workstation at, for example,the facility in which the database 104 is present, or in any othersuitable manner. Furthermore, instruments such as a sphygmomanometer,blood glucose measuring device, and so on, can be coupled to the patientterminal 110 to automatically input the patient's readings andmeasurements directly to the patient terminal 110 without the need formanual or electronic entry by the patient, nurse, and so on. Theterminal 110 can then be used to provide this data to the database 104in any of the manners described above.

[0048] It should be noted that the database 104 need not be configuredas a centralized database to store the data discussed above, such asthat pertaining to the guidelines and patient data. For example, theguideline data and patient data can be stored locally in theworkstations 106 and patient terminals 110, respectively, and integratedas appropriate as discussed in more detail below. Furthermore, even ifthe guideline data and patient data are stored in separate databases ordata storage locations, those separate databases or data storagelocations can be referred to generally as a data storage component.

[0049] As further illustrated in FIG. 2 and as discussed in more detailbelow, the network 102 generates stage disease management pathways 114that are integrated with the decision data sets 116 and referencecontent 118, which includes the patient-specific data, to generateclinical decision pathways 120. As also shown in FIG. 2 and discussed inmore detail below, the database 104 can be controlled by the computernetwork 102 to generate educational material 122 and outcome reports 124that take into account the patient-specific data.

[0050]FIGS. 3 and 4 illustrate an example of the manner in which theoperations involving the database 104, workstations 106 and patientterminals 110 shown in FIGS. 1 and 2 can address and eliminate theproblems associated with conventional stage disease managementtechniques discussed in the Background section above. For example, thedata entry sets can be provided by keyboard entry via the patientworkstations 110. The data entry sets can also be provided to thedatabase 104 via datasheets that are manually completed and scanned intoelectronic format, which is then forwarded to the database 104. The dataentry sets can also be remotely downloaded to the database 104 in anyfashion, and can also involve electronic medical records (EMR)interfacing to input the data to the database 104.

[0051] As further illustrated in FIGS. 3 and 4, the decision data setsfacilitate comparison of the existing patient state against the pathwaymodel as described in more detail below. The pathways are navigablelinks and are therefore easy to use by a healthcare provider. Thereference content is hyperlinked to the pathways and data sheets tofacilitate timely access by the healthcare provider. The clinicaldecision aspects of the database 104 provide outcomes reportingcapability which can be used by healthcare providers, and theeducational material aspects provide the patient with Internet access orclinician-generated materials to enable the patient to study informationabout his or her condition.

[0052] The manner in which an example of a system and method accordingto an embodiment of the present operates will now be described withreference to FIGS. 1, 2, and 5-24. Specifically, after the patientinformation has been entered into the database 104 in any of the mannersdescribed above, the network 102 can be controlled to generatetreatment, pathways or guidelines that take into the account thisparticular patient's data to enable a healthcare provider to diagnoseand prescribe treatment of the patient. When the healthcare provideraccesses the database 104 via, for example, a healthcare providerworkstation 106, the computer 102 can access the database 104 andprovide data to the workstation 106 that enables the workstation 106 togenerate a display 130 on its display screen as shown in FIG. 5. In thisexample, the guidelines and pathways generated relate to the diagnosisand treatment of diabetes. However, it can be appreciated that this typeof system and method can be employed to provide treatment pathways andguidelines for any type of disease, or can have any other medical ornon-medical application.

[0053] As shown in FIG. 5, the display 130 includes an alphabeticlisting of patient names. In this example, only two names are shown, butthe list can have as many names as the database 104 is capable ofsupporting.

[0054] If the healthcare provider is interested in using the system andmethod to obtain a diagnosis and treatment for the patient “Sandra Dee”,the healthcare provider can use, for example, the mouse at his or herworkstation 106 to click on the name “Sandra Dee.” This action causesthe web browser running on the workstations 106 to provide the necessarydata to network 102, which results in the network 102 retrieving theappropriate data from database 104 and providing that data back to theweb browser on the workstation 110. As illustrated in FIG. 6, this datacauses the workstation 110 to generate a display 132 illustrating ascreening and diagnosis pathway for the patient “Sandra Dee.” Thispathway can be generally referred to as a diagram, which can include thetype of pictorial display as illustrated. However, the term diagram canalso refer to other types of displays of the guideline information, suchas spreadsheet type displays, lists of information including theguidelines, and so on.

[0055] In this example, the display 132 includes a button column 133that enables the healthcare provider to generate various displays asdiscussed in more detail below. For example, the healthcare provider canclick on the button entitled “Screening & Diagnosis Data” to displayvarious boxes or components that show different guidelines that enable ahealthcare provider to determine, based on the data entered intodatabase 104 pertaining to “Sandra Dee”, whether or not the patient“Sandra Dee” has any form of diabetes. For example, box 134 displays thetypes of risk factors for diabetes, along with the symptoms beingexperienced by the patient “Sandra Dee” and the capillary blood glucose(BG) readings that would indicate that the patient is suffering from aform of diabetes. It is noted that in box 134, the risk factors that thepatient “Sandra Dee” meets are included. For example, the risk factorspertaining to dyslipidemia, ethnicity and family history are included.Also, symptoms such a blurred vision, UTI, dry/itchy skin, and so on areincluded. Furthermore, the results of the fasting blood glucose test asbeing greater than 100 mg/dL is highlighted.

[0056] As further illustrated in FIG. 6, box 136 highlights to thehealthcare provider that the test performed was a fasting plasma glucose(FPG) reading, as opposed to a casual plasma glucose (CPG) reading. Box138 highlights to the healthcare provider those diagnostic tests thatwere performed on the patient to indicate that the patient may have aform of diabetes.

[0057] Boxes 140, 142 and 144 similarly illustrate the differentpathways that the diagnoses can take depending on the results of thepatient's test. For example, box 144 indicates that the FPG of thepatient was determined to be 149 on Oct. 10, 2000, and thus, thisportion of box 144 is highlighted. Since box 144 is highlighted, thehealthcare provider can then follow the path to box 146 to see thereadings of the patient pertaining to the urine ketone. It is noted thatbox 146 indicates that the results of the urine ketone test werenegative on Oct. 11, 2000. The healthcare provider is thereforeinstructed to box 148 to repeat the FPG test in seven days. Thehealthcare provider is not instructed to proceed to box 150 to provide adiagnosis for Type 1 diabetes.

[0058] As further illustrated in FIG. 6, box 151 of the pathwayindicates to the healthcare provider that the FPG testing of the patientwas 160 mg/dL on Oct. 11, 2000, which is greater than the guideline of126 mg/dL. The pathway therefore indicates in box 152 that thehealthcare provider should diagnose the patient with Type 2 diabetes. Itis also noted that because the FPG level was greater than the guidelineset forth in box 150, the healthcare provider is not instructed toproceed to box 154 to diagnose the patient with impaired glucosehomeostasis. Also, because the patient's FPG level falls within theguidelines set forth in box 144, the pathway instructed the healthcareprovider to proceed along the boxes subsequent to box 144. Thehealthcare provider is not instructed to proceed to box 141 whichinstructs the healthcare provider to diagnose the patient as having nodiabetes.

[0059] In box 152, the healthcare provider is instructed to generate amaster decision path for the patient. By using the mouse on his or herworkstation 110 to click on the term “Type 2 master decision path”, theweb browser sends data to the network 102 which, in response, retrievesthe appropriate data from database 104 and provides that data to the webbrowser at workstation 110. The workstation 110 thus displays a displayscreen 160 as shown in FIG. 7. The boxes in the display screen 160provide the healthcare provider with various types of recommendation fordiet, exercise, and medication. For example, box 162 outlines a criteriafor the FPG being less than 200 mg/dL. Because the FPG of the patient isindicated as being 160 mg/dL on Oct. 11, 2000, box 162 indicates to thehealthcare provider to proceed to box 164 where the healthcare provideris instructed to prescribe a food plan and exercise for the patient. Byclicking on the term “food plan and exercise stage” in box 164, thehealthcare provider can control the web browser to provide aninstruction to the network 102 to retrieve the appropriate data fromdatabase 104. The network 102 provides this data to workstation 110,which causes the web browser to display a display 186 as shown in FIG.8.

[0060] As further shown in FIG. 8, the display 186 includes boxes 188through 204, which indicate to the healthcare provider recommendationsfor diet and exercise. For example, the diagnosis box 188 proceeds tobox 190 which indicates to the healthcare provider that the records ofthe patient's medical visit should be reviewed. The healthcare providercan review the medical visit records by clicking on the medical visitterm in box 190 to cause the web browser on the workstation 110 todisplay the medical visit display screen 191 as shown in FIG. 9, intowhich information pertaining to the patient's medical visit or visitscan be entered. As further shown in FIG. 8, box 192 provides informationto the healthcare provider for obtaining a registered dietician, whilebox 194 provides SMBG targets for the patient at different stagesthroughout the day.

[0061] Box 196 which follows box 190 also provides information for dietand exercise for the patient, while box 198 provides medical nutritiontherapy guidelines. Box 200 indicates to the healthcare provider theperiods of time in which the patient's medical condition should bereviewed and when the patient's recommended diet should also bereviewed. Box 202 provides a sample food plan that can be prescribed tothe patient. Box 204, which follows box 200, allows the healthcareprovider to adjust the food plan and exercise that was prescribed to thepatient if deemed necessary after performing the follow-ups recommendedin box 200.

[0062] Returning now to FIG. 7, it is noted that diagnosis boxes 166 and170 are displayed to the healthcare provider at workstation 110 toenable the healthcare provider to determine whether the patient hasreached the oral agent stage or the insulin stages. For example, if thepatient FPG is within the guidelines as recommended in box 166, then thepathway indicates in box 168 that the healthcare provider shouldprescribe oral agents to the patient for treatment of his or herdiabetes. Box 172 indicates a combination of oral agents that can beprescribed to the patient. In addition, box 170 indicates guidelines forFPG which would lead to the healthcare provider prescribing insulin fortreatment of the patient. That is, box 176 indicates the recommendationand guidelines for prescribing a combination of oral agent and insulinto the patient. Boxes 180-184 provide recommendations for differentdoses of insulin depending on the stage of the patient's diabetes. Boxes174 and 178 display types of medications that are typically prescribed,and also provide comments to the healthcare provider.

[0063] Based on the recommendations box 170, if the healthcare providerdetermines that the patient has reached insulin stage 2 indicated in box180, the healthcare provider can click on the term “insulin stage 2” inbox 180 to display insulin stage 2 start screen as shown in FIG. 10.Insulin stage 2 start screen 210 includes boxes 212 through 226 whichprovides guidelines and recommendations for prescribing insulin to thepatient. For example, box 212 sets forth guidelines concerning thepatient's FPG at diagnosis, while box 214 sets forth guidelines for apatient who is undergoing oral agent or combination therapy. If theseconditions in boxes 212 and 214 are met, the pathway in box 216recommends to the healthcare provider that the patient's medical historybe examined. The healthcare provider can achieve this by clicking on themedical visit term in box 216 to cause the web browser of workstation110 to display the medical visit display screen as shown in FIG. 9.

[0064] The display screen 210 shown in FIG. 10 also gives SMBG targetsin box 218 to assist the healthcare in making the diagnosis. Box 220,which follows box 216, provides a dose calculator to enable thehealthcare provider to prescribe a recommended amount insulin based thepatient's weight. That is, box 220 displays the patient's weight (i.e.,61.36 kgs) and the recommended dosage (i.e., 0.3 U/kg) for that weight.Box 221 also displays the recommended dosage, while the remainder of box220 breaks down that recommended dosage for morning, midday and eveningfor the patient, to arrive at the total daily units for the patient. Itis noted that if the recommend dosage changes to, for example, 0.4 U/kg,the healthcare provider can use the arrow in box 221 to adjust thedosage, which will change the breakdown of the dosage in the subsequentboxes for time of day and total daily units.

[0065] Box 222 in FIG. 10 provides LP considerations that can bereviewed by the healthcare provider. Box 224, which follows box 220,provides recommendations for a follow-up in a patient's medicalcondition and so on. Box 226, which follows box 224, enables thehealthcare provider to adjust the stage to insulin dosage if deemednecessary from the follow-up in box 224.

[0066] That is, if the healthcare provider determines that the insulinfor stage should be adjusted, the healthcare provider can use the mouseat his or her workstation 110 to click on the “insulin stage 2” adjustterm in box 226. By doing so, the web browser of the workstation 110displays a stage 2 adjust screen 230 as shown in FIG. 11. Stage 2 adjustscreen 230 includes boxes 232 through 252 which provide recommendationsto the healthcare provider to change the insulin based on certainconditions.

[0067] For example, box 234 takes into account the patient's interimhistory and physical conditions, as well as the laboratory results,while box 236 provides recommendations for considering different insulinstages. Box 238 considers whether the patient's SMBG is within thetarget range. If so, box 240 provides a recommendation that the patientmaintain the stage to insulin dosage. Box 242 considers the patient'smonthly assessment which, if improvement is shown, indicates that therecommendations in box 244 should be followed. If improvement is notshown, the guidelines recommended in box 246 that the patient'sday-to-day management be assessed, and box 248 provides guidelines todetermine whether the patient's dosage is sufficient. Box 250 enablesthe healthcare provider to provide a recommended adjustment to thepatient's insulin dosage. Box 252 provides recommendations for changingthe patient's dosage to follow the insulin stage 3 or insulin stage 4recommendations.

[0068] Returning to FIG. 7, if the healthcare provider determines fromthe diagnosis in box 170 that the patient should be given insulin stage3A dosage, the healthcare provider can use the mouse at his or herworkstation 110 to click on the insulin stage 3A term in box 182. Indoing so, the browser on workstation 110 will display the insulin stage3A start display screen 260 as shown in FIG. 12. The display screen 250includes boxes 262 through 276 which are similar to boxes 212 through226 in display screen 210 shown in FIG. 10 and which will not bedescribed in detail here. Returning to FIG. 7, if the healthcareprovider determines from the guidelines set forth in box 170 that thepatient should enter insulin stage 4A, the healthcare provider can usethe mouse at his or her workstation 110 to click on the term insulinstage 4A in box 184 to cause browser to display an insulin stage for astart screen 280 as shown in FIG. 13. Screen 280 includes boxes 282through 296 which are similar to boxes 262 through 276 shown in FIG. 12and boxes 212 and 226 shown in FIG. 10, and thus will not be describedin detail here. Also, box 276 in FIG. 12 and box 296 in FIG. 13 enablethe healthcare provider to provide insulin stage 3A adjustment andinsulin stage 4A adjustment, respectively, in a manner similar to theinsulin stage 2A adjustment as shown in the display screen 230 set forthin FIG. 11.

[0069] It is also noted that the various buttons in the button column133 on the displays discussed above which are displayed on the displayscreen of the workstation 110 can be used to generate additional displayscreens pertaining to the patient. For example, if the healthcareprovider clicks on the global patient data button, a group of additionalbuttons can be displayed as shown in FIG. 14. The healthcare providercan thus click on these additional buttons to cause the workstation 110to display, for example, a screen showing the patent's history inpresent illness (HPI), as well as ambulatory blood pressure (BP) asshown in display screen 300 in FIG. 15, and the patient's medicines andallergy information which can be entered in display screen 302 as shownin FIG. 16. The healthcare provider can also click on the data entrybutton to cause the workstation to display a patient data entry screen304 as shown in FIG. 17. The healthcare provider can also click on anyof the other buttons to display screens for performing additional tasks.

[0070] For example, the healthcare provider can click on the outcomesreporting button to display reports on patient progress. Moreparticularly, the outcomes reporting button could be clicked on todisplay population data reports, such as NCQA, HEDIS or JCAHO reports,which are of critical importance to Health Care Organizations insecuring and maintaining various forms of accreditation, and show acompilation of different patient data that can be provided to thoseorganizations. The healthcare provider can click on the orders andreferrals button to view medical orders and referrals that have beengiven to the patient. These orders and referrals can include templatesor letters into which the patient data and diagnosis data can beautomatically entered by the system, thereby obviating the need forredundant documentation by the clinician. That is, if the referral is areferral letter to a type of specialist, such as a nutritionist, thepatient diagnosis (e.g., Type 2 diabetes) and patient data (e.g., SBGLreadings) can be automatically inserted into the letter simply by thenature of the actions that the user takes while navigating the pathwayscreen(s) for the purpose of managing their patient or entity.

[0071] The healthcare provider can also click on any of the otherbuttons in button column 133 to display the desired display screens. Forexample, clicking on the patient documentation button will display thepatient information such as the data that is in a patient's chart.Clicking on the screen and diagnose button will display the screen anddiagnose display screen 132 as shown in FIG. 6, and clicking on thestart food plan and exercise button will display the food plan andexercise display screen 186 as shown in FIG. 8. Clicking on the startinsulin display screen button will enable the healthcare provider todisplay the selected insulin display screen as shown in FIGS. 10, 12 and13, and clicking on the adjust insulin display screen will show aninsulin adjustment display screen as shown in FIG. 11. Clicking on thestart oral or start/manage pump buttons will display appropriatepathways similar to those shown in FIGS. 10, 12 and 13 but which pertainto oral or pump-administered medications. Clicking on the SOAP(subjective objective assessment and plan) button will display a displayscreen into which the healthcare provider can enter additional SOAPnotes, beyond those automatically generated by the system in conjunctionwith the user's use of the system, as can be appreciated by one skilledin the art. Clicking on the select therapy button displays the masterpathway as shown in FIG. 7. Clicking on the print button will enable thehealthcare provider to print the displayed screen, and clicking on thehome button returns the display to that shown in FIG. 5.

[0072] In addition, an appropriate button, such as the education button,can be clicked on to display self-management and adherence assessmentdisplay screen 310 as shown in FIG. 18 that includes boxes 312 through334 which provide questions for the patient to answer andrecommendations for the patient and will process those questions.Furthermore, the healthcare provider can click on the complicationsbuttons to be able to diagnose whether or not the patent is developingany complications and then treatment pathways can provide guidance ontheir treatment For example, by clicking on the complication button, theworkstation 110 can display a hypertension and diagnosis display screen340 as shown in FIG. 19. The hypertension diagnosis display screen 340includes boxes 342 through 362 which assist a healthcare provider indetermining whether or not the patient is developing hypertension. Forexample, box 342 indicates that the patient with Type 1 or Type 2diabetes can be suffering from hypertension, and subsequent box 344instructs the healthcare provider to measure blood pressure and reviewprevious blood pressure values. Box 346 provides blood pressuremeasurement guidelines. In addition, if the healthcare provider clickson the box “R” in box 346, the workstation will display a dropdown boxshowing normal blood pressure range and diabetes blood pressure rangesas shown in FIG. 20.

[0073] The additional boxes in display screen 340 similarly ask thehealthcare provider questions to assist the healthcare provider with thediagnosis. If the healthcare provider reaches box 362, a recommendationis give to diagnose the patient with hypertension. The healthcareprovider can then click on the hyper tension-start treatment term in box362 to display a hypertension drug therapy start display screen 370 asshown in FIG. 21. The hypertension drug therapy start display screen 370includes boxes 372 through 384 which provide recommendation forhypertension therapy treatment to the healthcare provider. Thehealthcare provider can also click on a hypertension drug therapy adjustterm in box 380 to cause the workstation 110 to display a hypertensiondrug therapy adjustment screen (not shown) to adjust the hypertensiontherapy drugs and treatment.

[0074] Returning to FIG. 6, the button column 133 also enables thehealthcare provider to display a diagnosis screen as shown in FIG. 22, apatient basic intake screen is drawn in FIG. 23, and a print screen asshown in FIG. 24.

[0075]FIGS. 25 and 26 illustrate variations in the manner in which thesystem and method according to another embodiment of the presentinvention can control the workstation 110 to display display screenshaving different arrangements of the information and pathways discussedabove. For example, when the healthcare provider accesses the database104 via, for example, a healthcare provider workstation 106, thecomputer 102 can access the database 104 and provide a data to theworkstation 106 that enables the workstation 106 to generate a display400 on its display screen as shown in FIG. 25.

[0076] Similar to the display 130 shown in FIG. 5, the display 400includes a listing of patient names. However, unlike display 130,display 400 lists the names chronologically by order of appointmenttime. In addition, display provides certain patient informationassociated with the patient's name. For example, the patient's HbA1c,blood pressure and LDL readings are displayed) if known), along with anindication as to whether the patient is a smoker. The display 400 can beconfigured to include any other patient-related information as deemedappropriate.

[0077] As with screen 130, if the healthcare provider is interested inusing the system and method to obtain a diagnosis and treatment for aparticular patient, the healthcare provider can use, for example, themouse at his or her workstation 106 to click on the name of interest.This action causes the web browser to generate a display 402illustrating a screening and diagnosis pathway for the patient, as shownin FIG. 26. In this example, display 402 shows a “Type 2 Insulin Adjust”pathway for illustrative purposes. However, it should be understood thatthe system and method can be configured so that the web browserinitially displays, for example, a screening and diagnosis displayscreen, or any other suitable type of display and pathway.

[0078] As indicated, display 402 includes a pathway section 404 which,like the other pathways described above, includes a pathway comprising aplurality of boxes 406 through 422 setting forth guidelines that assista health care provider is treating the patient. Also, like the otherpathways described above, pathway section 404 highlights the patient'sconditions based on the patient data. In other words, pathway section404 also integrates the patient data with the guidelines. For example,because the patient has nocturnal hypoglycemia, the term “nocturnalhypoglycemia” is conscripted by a highlighted rectangle in box 406 as aconsequence of the SMBG data presented on the left side of the screen.Likewise, because the patient's SMBG and/or HbA1c is within the targetrange, the term “in target range” is conscripted by a highlightedrectangle in box 412. The health care provider can therefore use thisinformation in the guidelines in conjunction with the actual values, todetermine a course of treatment for the patient in a manner similar tothat discussed above.

[0079] In addition, display 402 includes a patient data section 408 thatdisplays patient data such as the patient's HbA1c reading, bloodpressure (BP) reading, and so on. Display 402 also includes a data viewssection 410 that provides an indication of the type of data view that iscurrently being displayed in the data view section 412. In this example,the data view being displayed is a 30 day Modal of SMBG, as indicted.The healthcare provider can click on one of the other options, such asthe “7 day logbook”, in the data views section 410 to display the 7 daylogbook relating to the patient in the data view section 412. TheDiagnosis & Pathways section 414 indicates the type of pathway that isbeing displayed in the pathway section 404. In this case, the Type 2Insulin Adjust pathway is being displayed, as indicated. The healthcareprovider can select a different pathway for display, such as the“Complication 1” pathway, and so on, by clicking on the appropriate termin the Diagnosis & Pathways section 414. The Current Therapies section416 indicates the type of therapy (e.g., insulin) that the patient isundergoing.

[0080] As further shown in FIG. 26, the display 402 includes buttonsincluding the terms “Type 1 Diabetes”, “Gestational”, and so on, whichextend vertically on opposite sides of the pathway section 404. As withthe buttons in button column 133 as discussed above, the healthcareprovider can click on any of these buttons to display a pathwaypertaining to the term indicated on the button being selected. Forexample, if the healthcare provider clicks on the “Type 1 Diabetes”button, the display 402 will display a pathway showing guidelines fortreating Type 1 diabetes. In this event, the terms displayed in theDiagnosis & Pathways section 414 will also change to reflect the pathwaybeing displayed in the pathway section 404. Additionally, the datavariables being presented on the left screen half may also change tothose relevant specifically to the new flow chart Pathway beingaccessed.

[0081] As further indicated in FIG. 26, display 402 includes anEducation Checklist section 418 that can include a list of educationthat any patient should have for any pathway. For example, for the Type2 Insulin Adjust pathway being displayed in pathway section 404, thehealthcare provider can click on the Education Checklist section 418 todisplay a dropdown menu indicating recommended patient education, suchas self-monitoring education, for that particular pathway. The display402 also includes a subjective-objective assessment and plan (SOAP)section in which can be displayed notes that are entered by thehealthcare provider, along with patient data, and so on.

[0082] As stated above the above system and method deem not be limitedto the treatment of diabetes, but rather can be applied to any medicaltreatment as can be appreciated by one skilled in the art.

[0083] Although only a few exemplary embodiments of this invention havebeen described in detail above, those skilled in the art will readilyappreciate that many modifications are possible in the exemplaryembodiments of that material and departing from the novel teachings andadvantages of this invention. Accordingly, all such modifications areintended to be included within the scope of this invention as defined inthe following claims.

What is claimed is:
 1. A system for integrating guidelines with data,comprising: a data storage component, adapted to store guideline datarepresenting at least one of guidelines for assessing a condition of anentity and guidelines for taking action on said entity, and to storefeature data representing at least one feature of said entity; and anoutput device, adapted to output at least one diagram representing saidguideline data, said diagram including at least one componentrepresenting a relationship of at least a portion of said feature datato at least a portion of said guideline data.
 2. A system as claimed inclaim 1, wherein: said output device includes a display, adapted todisplay said diagram.
 3. A system as claimed in claim 1, wherein: saidentity is a person, said feature data represents at least one physicalcondition of said person, and said guideline data represents medicalinformation.
 4. A system as claimed in claim 3, wherein: said physicalcondition includes a form of diabetes, and said medical informationpertains to diabetes.
 5. A system as claimed in claim 1, wherein: sadoutput device is further adapted to generate an output which is separatefrom said diagram and includes information determined from saidrelationship of at least a portion of said feature data to at least aportion of said guideline data.
 6. A system as claimed in claim 5,wherein: said output includes one of a display and a printable document.7. A system as claimed in claim 1, wherein: said output device isfurther adapted to selectably generate a plurality of said diagrams,each of which representing different said guideline data.
 8. A system asclaimed in claim 1, wherein: said output device is further adapted tohighlight at least a portion of said diagram based on said feature data.9. A system as claimed in claim 1, wherein: said diagram includes aleast one component which is adapted to cause said output device tooutput information pertaining to said at least one component of saiddiagram.
 10. A system as claimed in claim 1, further comprising: atleast one database input, adapted to input one of said guideline dataand said feature data into said database.
 11. A method for integratingguidelines with data, comprising: storing guideline data representing atleast one of guidelines for assessing a condition of an entity andguidelines for taking action on said entity; storing feature datarepresenting at least one feature of said entity; and outputting atleast one diagram representing said guideline data, said diagramincluding at least one component representing a relationship of at leasta portion of said feature data to at least a portion of said guidelinedata.
 12. A method as claimed in claim 11, wherein: said outputtingincludes displaying said diagram.
 13. A method as claimed in claim 11,wherein: said entity is a person, said feature data represents at leastone physical condition of said person, and said guideline datarepresents medical information.
 14. A method as claimed in claim 13,wherein: said physical condition includes a form of diabetes, and saidmedical information pertains to diabetes.
 15. A method as claimed inclaim 11, further comprising: generating an output which is separatefrom said diagram and includes information determined from saidrelationship of at least a portion of said feature data to at least aportion of said guideline data.
 16. A method as claimed in claim 15,wherein: said output includes one of a display and a printable document.17. A method as claimed in claim 11, wherein: said outputting includesselectably generating a plurality of said diagrams, each of whichrepresenting different said guideline data.
 18. A method as claimed inclaim 11, wherein: said outputting includes highlighting at least aportion of said diagram based on said feature data.
 19. A method asclaimed in claim 11, wherein: said diagram includes a least onecomponent which is adapted to cause an output device to outputinformation pertaining to said at least one component of said diagram.20. A method as claimed in claim 11, further comprising: inputting oneof said guideline data and said feature data for storage by saidstoring.
 21. A computer-readable medium of instructions, adapted tocontrol a system to integrate guidelines with data, comprising: a firstset of instructions, adapted to control said system to store guidelinedata representing at least one of guidelines for assessing a conditionof an entity and guidelines for taking action on said entity; a secondset of instructions, adapted to control said system to store featuredata representing at least one feature of said entity; and a third setof instructions, adapted to control said system to output at least onediagram representing said guideline data, said diagram including atleast one component representing a relationship of at least a portion ofsaid feature data to at least a portion of said guideline data.
 22. Acomputer-readable medium of instructions as claimed in claim 21,wherein: said third set of instructions is adapted to control saidsystem to output said diagram by displaying said diagram on a display.23. A computer-readable medium of instructions as claimed in claim 21,wherein: said entity is a person, said feature data represents at leastone physical condition of said person, and said guideline datarepresents medical information.
 24. A computer-readable medium ofinstructions as claimed in claim 23, wherein: said physical conditionincludes a form of diabetes, and said medical information pertains todiabetes.
 25. A computer-readable medium of instructions as claimed inclaim 21, further comprising: a fourth set of instructions, adapted tocontrol said system to generate an output which is separate from saiddiagram and includes information determined from said relationship of atleast a portion of said feature data to at least a portion of saidguideline data.
 26. A computer-readable medium of instructions asclaimed in claim 25, wherein: said output includes one of a display anda printable document.
 27. A computer-readable medium of instructions asclaimed in claim 21, wherein: said third set of instructions is furtheradapted to control said system to selectably generating a plurality ofsaid diagrams, each of which representing different said guideline data.28. A computer-readable medium of instructions as claimed in claim 21,wherein: said third set of instructions is further adapted to controlsaid system to highlight at least a portion of said diagram based onsaid feature data.
 29. A computer-readable medium of instructions asclaimed in claim 21, wherein: said diagram includes a least onecomponent which is adapted to cause an output device to outputinformation pertaining to said at least one component of said diagram.30. A computer-readable medium of instructions as claimed in claim 21,further comprising: a fifth set of instructions, adapted to control saidsystem to input one of said guideline data and said feature data forstorage.